Derotation brace for tibia deformities



1967 e. R. CALLENDER, JR

DERQTATION BRACE FOR TIBIA DEFORMITIES 2 Sheets-Sheet 1 Filed July 24,1964 George R- Cal/ena'er. Jr.

INVENTOR.

WW Em Filed July 24, 1964 DEROTATION BRACE FOR TIBIA DEFORMITIES 2Sheets-Sheet? Fly. .2

George R. Ca/Iender, Jr.

IN VEN TOR Mafia BY arm WW 157M138],

United States Patent 3,304,937 DEROTATION BRACE FOR TIBIA DEFORMITIESGeorge R. Callender, Jr., 1308 Quarrier St., Charleston, W. Va. 25301Filed July 24, 1964, Ser. No. 384,883 Claims. (Cl. 12880) The presentinvention generally relates to a brace for use in correcting a deformityof the lower leg bone or tibia especially in children.

Two components of this type of deformity are recognized, namely, theactual twisting of the bone about its longitudinal axis and itsassociated lateral bowing. In order to correct the deformity, both ofthe components of the deformity should be correct simultaneously. Thebrace of the present invention accordingly has for its object thesimultaneous correction of the twisting of the bone and its associatedbowing and is termed a derotation brace for correcting deformities ofthe tibia or the lower bone or bones of the leg where the bone istwisted such that the foot turns in or out.

The present invention generally consists of an elongated leg type ofbrace constructed so that it will hold the knee bent at a ninety degreeangle and including a cuff at the upper end of a bar for attachmentthereof to the thigh together with a cuff for attachment to the leg atthe calf level in order to maintain the leg in proximity to the brace atthe calf level. A foot piece is attached to the lower end of the bar ina manner which allows rotation of the foot free of the bar when loosenedand capable of being tightened to hold the foot firmly in a fixedrotation position thereby obtaining correction of the deformity ofbowing and of rotation by first rotating the foot piece to the point ofresistance and waiting for the bone to respond to this stress.Similarly, the bowing of the leg is corrected by pressure from the calfcuff against the apex of the convexity of the leg bone or tibia. Thesimultaneous use of the derotation and the pressure at the apex of theconvex curve of the bowing results in a progressive correction of thedeformity.

Another object of the present invention is to provide a brace inaccordance with the preceding paragraph which is simple in construction,easy to apply and remove, effective for its particular purposes andrelatively inexpensive to manufacture.

These together with other objects and advantages which will becomesubsequently apparent reside in the details of construction andoperation as more fully hereinafter described and claimed, referencebeing bad to the accompanying drawings forming a part hereof, whereinlike numerals refer to like parts throughout, and in which:

FIGURE 1 is a side elevational view of the brace of the presentinvention installed on the leg of a child;

FIGURE 2 is a posterior view in elevation illustrating the orientationof the components of the brace and illustrating in dotted line thepositioning of the calf cuff in relation to the apex of the convex curveof the leg bone;

FIGURE 3 is a bottom plan view illustrating the rotational adjustmentfeature for varying the angular position of the foot;

FIGURE 4 is a detailed sectional view illustrating the construction ofthe connection between the bar and the derotation adjustment mechanism;and

FIGURE 5 is an exploded group perspective view of 3,304,937 PatentedFeb. 21, 1967 the derotation connection between the bar and foot piece.

Referring now specifically to the drawings, the numeral 10 generallydesignates the brace of the present invention which includes anelongated rigid bar 12 having a top portion 14 underlying the thighregion of the leg. A ninety degree bend 16 is formed at the forward endof the top portion 14 of the bar 12 and an elongated verticallydepending portion 18 extends downwardly from the bend 16. Attached tothe vertically elongated portion 18 of the bar 12 is an L-shapedsupporting bar 20 having a vertically elongated portion 22 overlappingand secured to the vertical portion 18 of the bar 12. A pair ofscrewthreaded fasteners 24 are provided for adjustably securing thevertical portion 22 to the vertical portion 18 in longitudinallyadjusted position by virtue of there being provided a plurality oflongitudinally spaced screwthreaded openings 26 in the vertical member22 thereby enabling the effective vertical length of the brace to beadjusted. At the lower end of the vertical portion 22, there is provideda ninety degree bend 28 and a forwardly extending horizontal portion 30generally circular in configuration and including a circular plate 32rigidly afiixed thereto and having a plurality of radial serrations 34projecting from the top surface thereof. The serrations 34 are formed indiametrically opposed arcuate arrangements as illustrated in FIGURE 5and the plate 32 may be secured to the horizontal member 30 by anysuitable means such as by rivets 36 or the like. The horizontal member30 and the plate 32 are each provided with an opening 38 for receiving adepending threaded bolt 40 on a foot receiving member 42. The lower endof the threaded bolt 40 receives a Washer 44 and an externally knurledand internally threaded thumb nut 46 for ease of manipulation of the nut46.

The foot receiving assembly includes a U-shaped bracket 48 having abight portion 50 and a pair of upwardly extending legs 52 which areinitially curved out- Wardly as at 54 and then curved inwardly andupwardly as at 56. The free ends of the U-shaped bracket 48 are attachedto a U-shaped counter-stirrup 58 by a pair of rivets 68 or the like. TheU-shaped counter-stirrup 58 is disposed horizontally and is curved toconform with and engage the heel enclosing portion of a shoe. The bottomof the bight portion 50 of the U-shaped bracket 48 is provided with acircular plate 62 having depending radial serrations 64 thereon formatching adjustable engagement with the serrations 34. The plate 62 ismounted on the bracket 48 by suitable rivets 66 or the like and the bolt40 extends through an opening in the plate 62 designated by numeral 68and also through the bight portion 50 of the bracket 48 and terminatesin a head 70 engaging the top surface of the bight portion 50 of thebracket 48 in a rigid and secure manner thereby retaining the bolt inposition.

As illustrated in FIGURE 4, a partial shoe generally designated bynumeral 72 is attached to the stirrup 58 by virtue of a rivet 74extending through the bight portion of the stirrup designated by numeral76 and through the rear of the heel enclosing portion or counter 78 ofthe partial shoe 72. It is noted that the lower edge of the stirrup 76overlies the peripheral edge of the outer sole 80 of the partial shoe 72and conforms closely with the contour thereof.

The forward ends of the legs 82 of the stirrup 58 curve slightlyinwardly as designated by numeral 84 to conform with the curvature ofthe shoe upper or counter 78. The forward end of the shoe upper iscut-away along a line designated by numeral 36 and the usual shoelacings 88 are provided thus leaving the toe region 90 of the foot ofthe wearer free to eliminate toe deformation during correction ofdeformities in the lower leg bone or tibia.

On the top portion 14 of the bar 12, there is provided a generallyU-shaped rigid saddle or receiver 90 afiixed to the top portion 14 byrivets 93 or the like. The saddle 90 preferably is of metal constructionand has a cuff 94 of flexible canvas-like material or the like securedthereto as by rivets 96. The saddle 9t) is preferably covered with acanvas-like fabric and the cuff 94 is provided with an overlappingportion 98 secured in position by lacing 100 and a suitable knot 102.

Below the ninety degree bend 16, a U-shaped rigid saddle or receiver 104is provided adjacent the calf of the leg 106 of the wearer. The saddleor receiver 104 is affixed to the vertical portion 18 by rivets 108 andis preferably constructed of metal and provided with a fabriccanvas-like covering. A calf cuff 110 is attached to the saddle 104 byrivets 112 and the ends of the calf cuff overlap as at 114 and aresecured in overlapping adjusted position by a buckle assembly 116 and astrap-like member 118 for securing the calf cuff 110 to the calf of theleg thus maintaining the leg 106 in ninety degree relationship to thethigh region 122 of the leg with the knee 120 defining the vertex ofsuch angular relationship. Also, the calf cuff 110 is located at theapex 124 of the convex curvature of the lower leg bone or tibia 126 asillustrated in FIGURE 2.

The present brace is provided for an individual leg and may be used onan individual leg if that is all that is necessary to correct adeformity in one leg or it may be used in conjunction with anothersimilar brace for correcting deformities in both legs. In any event, thelegs are never connected together and each individual leg may becorrected by rotation of only the lower portion of the leg by virtue ofthe positioning of the knee 120 at a ninety degree angle. In the presentbrace, the correction force is applied through the longitudinal axis ofthe tibia 126 with the knee 120 in a flexed or ninety degree bentposition in order that the entire derotation force is transmittedthrough the lower calf portion of the leg rather than through the entireleg structure to the hip (not shown). This brace further adds acorrective feature in the particular placement of the pressure pad orcalf cuff 110 along the lateral aspect of the leg which affordscorrection of the bowing deformity of the lower leg or calf portion asat 124, which is only possible in the bent knee position. This featureis clearly illustrated in the posterior view of FIGURE 2 wherein it isclear that the calf cuff 110 is closer to the upper end portion 14 ofthe rigid vertical brace bar means shown disposed vertically alongsidethe posterior of the calf portion of the leg. The lateral bowing of theleg bone may be somewhat exaggerated in FIGURE 2 in order to clearlyillustrate the point where the point of pressure of the lateral portionof the calf cuff exerts a corrective force to the bowing of the lowerleg.

The manner of attachment to the shoe may be varied. The one illustratedmay be provided or there may be an arrangement in which the shoe is heldin the counter stirrup by the use of a strap extending across the ankleregion of the foot thus holding the shoe to the brace.

By using the brace of the present invention, correction of the deformityof bowing and of rotation is corrected by first rotating the foot pieceto the point of resistance and waiting for the bone to respond to thisstress. Similarly the bowing of the leg is corrected by pressure fromthe calf cuff against the apex of the convexity of curvature of the legbone. The simultaneous use of the knee rotation and the pressure at theapex of the convex curve of the bowing results in a progressivecorrection of the deformity. With the present invention, the center ofthe axis of derotation is beneath the longitudinal axis of the tibia andthe pressure point to afford derotation is placed near the sustentaculumtali which is slightly anterior to the axis of rotation and is roughlyequidistant from the axis of rotation as in the oscalcis as it is placedin the heel counter.

By utilizing a shoe, this allows for the simultaneous correction of pesplanus deformity. However, in order to prevent the possibility of theproduction of a valgoid deformity of the foot in the derotation ofinternal tibial torsion, the forefoot of the shoe is removed asillustrated. Since the pressure is placed basically at the sustentaculumtali there has been no incidence of the deformity of the valgus of theforefoot by the utilization of the present invention.

The foregoing is considered as illustrative only of the principles ofthe invention. Further, since numerous modifications and changes willreadily occur to those skilled in the art, it is not desired to limitthe invention to the exact construction and operation shown anddescribed, and accordingly all suitable modifications and equivalentsmay be resorted to, falling within the scope of the invention asclaimed.

What is claimed as new is as follows:

1. A derotation leg brace for treatment of internal torsion or externaltorsion of the tibia bone comprising a rigid vertical brace bar meansadapted to be positioned vertically alongside the posterior of the calfportion of the leg of a wearer, means carried by said vertical brace barmeans adapted to embrace the leg of a wearer at the calf portion anddispose the vertical brace bar means in positive position, said verticalbrace bar means having a rigid upper end portion disposed at asubstantially 90 degree angle thereto and extending rearwardly therefromand adapted to underlie the thigh portion of a wearers leg with the legbeing bent at approximately a 90-degree angle at the knee, means carriedby the upper end portion adapted to embrace the thigh portion of the legof a wearer, said vertical brace bar means having a rigid lower endportion disposed at a substantially 90-degree angle thereto andextending forwardly therefrom in an opposite direction from the upperend portion, said lower end portion being adapted to underlie the heelof the foot of a wearers leg, means adapted to embrace and support thehindfoot portion of a wearers foot, means mounting the hindfoot supportmeans to the lower end portion of the vertical brace bar means forrotation about a vertical axis spaced from the vertical brace bar meansand parallel thereto so as to be in substantial vertical alignment withthe tibia bone of a wearers leg and directly beneath the shaft of thetibia bone and means for locking the hindfoot support means in selectedpositions of rotation relative to the said lower end portion.

2. The invention of claim 1, wherein said means adapted to embrace theleg of a wearer at the calf portion is a cuff-like arrangement locatedon the vertical brace bar means closer to the upper end portion than thelower end portion and adapted to embrace the calf portion at the apex ofthe convex curvature of the tibia bone.

3. The invention of claim 2, wherein said vertical brace bar means isadjustable lengthwise along its longitudinal axis between the upper andlower end portions.

4. The invention of claim 1, wherein said means mounting the hindfootsupport means for rotation includes a bracket means carried by thehindfoot support and underlying the same and carrying bolt meansincluding a bolt shank passing through a vertical opening in the lowerend portion of the vertical brace bar means.

5. The invention of claim 4, wherein said locking means includes acircular plate carried by the bracket means and through which the boltshank of the bolt means passes and a complementary circular plateprovided on the lower end portion and through which the bolt shankpasses, said plates having complemental faces formed with interlockingradial serrations and the bolt means includes -a locking nut arrangementon the bolt shank below the lower end portion for locking the platestogether with their serrated faces in interlocked disposition.

5 References Cited by the Examiner UNITED STATES PATENTS 2,531,48611/1950 Weber 128-80 2,967,360 1/1961 Rice 128-89 1 3,086,522 4/1963Frohmader 128-80 6 FOREIGN PATENTS 497,992 10/1919 France.

OTHER REFERENCES BrowneNight Splint, J. of Bone and Joint Surgery, 44-A;5, July 1962, adv. page 43.

New Horizons in Brace Research, November 1950, pages 11-12, illus. 12.

RICHARD A. GAUDET, Primary Examiner. J. W. HINEY, Assistant Examiner.

1. A DEROTATION LEG BRACE FOR TREATMENT OF INTERNAL TORSION OR EXTERNALTORSION OF THE TIBIA BONE COMPRISING A RIGID VERTICAL BRACE BAR MEANSADAPTED TO BE POSITIONED VERTICALLY ALONGSIDE THE POSTERIOR OF THE CALFPORTION OF THE LEG OF A WEARER, MEANS CARRIED BY SAID VERTICAL BRACE BARMEANS ADAPTED TO EMBRACE THE LEG OF A WEARER AT THE CALF PORTION ANDDISPOSE THE VERTICAL BRACE BAR MEANS IN POSITIVE POSITION, SAID VERTICALBRACE BAR MEANS HAVING A RIGID UPPER END PORTION DISPOSED AT ASUBSTANTIALLY 90 DEGREE ANGLE THERETO AND EXTENDING REARWARDLY THEREFROMAND ADAPTED TO UNDERLIE THE THIGH PORTION OF A WEARER''S LEG WITH THELEG BEING BENT AT APPROXIMATELY A 90-DEGREE ANGLE AT THE KNEE, MEANSCARRIED BY THE UPPER END PORTION ADAPTED TO EMBRACE THE THIGH PORTION OFTHE LEG OF A WEARER, SAID VERTICAL BRACE BAR MEANS HAVING A RIGID LOWEREND PORTION DISPOSED AT A SUBSTANTIALLY 90-DEGREE ANGLE THERETO ANDEXTENDING FORWARDLY THEREFROM IN AN OPPOSITE DIRECTION FROM THE UPPEREND PORTION, SAID LOWER END PORTION BEING ADAPTED TO UNDERLIE THE HEELOF THE FOOT OF A WEARER''S LEG, MEANS ADAPTED TO EMBRACE AND SUPPORT THEHINDFOOT PORTION OF A WEARER''S FOOT, MEANS MOUNTING THE HINDFOOTSUPPORT MEANS TO THE LOWER END PORTION OF THE VERTICAL BRACE BAR MEANSFOR ROTATION ABOUT A VERTICAL AXIS SPACED FROM THE VERTICAL BRACE BARMEANS AND PARALLEL THERETO SO AS TO BE IN SUBSTANTIAL VERTICAL ALIGNMENTWITH THE TIBIA BONE OF A WEARER''S LEG AND DIRECTLY BENEATH THE SHAFT OFTHE TIBIA BONE AND MEANS FOR LOCKING THE HINDFOOT SUPPORT MEANS INSELECTED POSITIONS OF ROTATION RELATIVE TO THE SAID LOWER END PORTION.